1. Baseline Vital Signs
FGTC 2010 EMT-I

2. Topics Gathering patient information Baseline vital signs
Breathing, pulse, skin condition, ans pupils
Blood pressure and orthostatic vital signs
Pulse oximetry
Reassessing vital signs
SAMPLE history
Overview of the topics to be discussed.
FGTC 2010 EMT-I

3. Introduction
This chapter is the EMT’s first introduction to the concept of assessment
Patient assessment is a highly critical skill which must be performed on each patient by the EMT
Tell the students that it is from this assessment that the patient–provider interaction is established, and it forms the basis of all management interventions.
FGTC 2010 EMT-I

4. Gathering Info
Gathering patient information occurs through a variety of mechanisms. Much information is gained by just visually assessing the patient and scene. You may also employ the use of communication, auscultation, and palpation skills for those clinical conditions that require more “detective” work to ascertain.
No comment.
FGTC 2010 EMT-I

5. Gathering Info General patient information gathered first
Chief complaint
Patient’s primary complaint for summoning EMS
Age
Years, months, days
Gender (sex)
Ethnicity (race)
This is information which is gathered early and quickly by the EMT. This allows the initial field impression to be formed. For example, if the EMT was faced with a 19-year-old male with abdominal pain, the EMT could safely conclude that the source of abdominal pain was NOT from a ruptured ectopic pregnancy.
FGTC 2010 EMT-I

6. Baseline Vital Signs
These “signs of life” often provide clues into what is happening inside the body
Repeated assessment and interpretation of these vital signs give clues to the patient’s continued improvement or deterioration
The first set of vitals are considered to be the “baseline vitals,” to which subsequent measurements can be compared
You can’t get inside the patient’s body to see what is going on, but you can measure the vital signs. These are the “signs of life”—outward signs that give clues to what is happening inside the body. The vital signs that you will measure are:
 Breathing
 Pulse
 Skin
 Pupils
 Blood pressure
FGTC 2010 EMT-I

7. Baseline Vital Signs Vital signs that are assessed include:
Breathing, pulse, blood pressure
Skin characteristics and pupils
Pulse oximetry
Give an overview of the importance and relevance of obtaining the patient’s vital signs.
1-5.1 Identify the components of vital signs.
FGTC 2010 EMT-I

8. Baseline Vital Signs Equipment for assessing vitals: Sphygmomanometer
Stethoscope
Wristwatch
Penlight
Pen and pocket notebook for recording information
Your personal protective equipment
While you can monitor most of the vital signs with your senses (looking, listening, feeling), it is necessary that you use and routinely carry the following equipment:
 A sphygmomanometer (blood pressure cuff) in adult and pediatric sizes to measure blood pressure
 A stethoscope to take blood pressure and listen to lung sounds
 A wristwatch that counts seconds to measure pulse and respiratory rates
 A penlight to examine pupils
 A pair of EMT shears for cutting away clothing
 A pen and pocket notebook for entering vital signs and other findings
 Your personal protective equipment for body substance isolation, such as protective gloves, eyewear, and face mask
FGTC 2010 EMT-I

9. Baseline Vital Signs Breathing rate
The respiratory rate is assessed by observing the patient’s rise and fall of the chest
Assessing breathing adequacy is critical in patients, and is comprised of two different (but related) assessment parameters. The “respiratory rate” refers to how many times a patient breathes a minute, while the “tidal volume” represents how deep each breath is. Thus, the “minute ventilation” equals the amount of air breathed in and out in one minute, as reflected by the quality of both the respiratory rate and tidal volume.
1-5.2 Describe the methods to obtain a breathing rate.
FGTC 2010 EMT-I

10. Baseline Vital Signs Breathing rate
The rate is calculated by counting the number of breaths in 30 seconds and multiplying by two
The EMT needs to be familiar with normal respiratory rates in patients:
The breathing (respiratory) rate is assessed by observing the patient’s chest rise and fall. The normal respiratory rate for an adult patient at rest is typically between 12 to 20 breaths per minute. Typically respiratory rates that are less than 10 or greater than 24 are of a concern. Normal rates in children are 15 to 30 per minute, while infants are 25 to 50 per minute.
1-5.3 Identify the attributes that should be obtained when assessing breathing.
FGTC 2010 EMT-I

11. Baseline Vital Signs Breathing quality
Assessing tidal volume is also commonly referred to as assessing the breathing “quality”
Assess for tidal volume while simultaneously obtaining the respiratory rate
Determining quality of breathing, or respiration, is as important as determining rate. It will tell you the volume of air moving in and out of the lungs per minute and how well it is moving. The quality of breathing may be normal or abnormal. An abnormal quality of breathing may be shallow, labored, or noisy. You can assess the quality of breathing while you are counting the rate.
Normal breathing is breathing which has about 1” of chest wall movement, is effortless, quiet, and is free from abnormal sounds or noises. Any deviation from the above represents a patient who is struggling to breathe, and may still have adequate breathing, but could rapidly deteriorate without warning.
FGTC 2010 EMT-I

12. Baseline Vital Signs Breathing quality
Quality can be placed in one of four categories:
Normal
Shallow
Labored
Noisy
Normal breathing involves average chest wall motion, which is at least one inch of expansion in an outward direction. The patient does not use the accessory muscles of the chest, neck, or abdomen while breathing. Rate is normal, and inhalations and exhalations are about the same length. Normal breathing is quiet; it does not produce abnormal sounds or noises.
Shallow breathing is indicated by only slight chest or abdominal wall expansion on inhalation.
Labored breathing, where the patient is working hard to breathe, is indicated by an abnormal sound of breathing that may include grunting or stridor (a harsh, high pitched sound), the use of accessory muscles in the neck, chest, or abdomen to breathe, nasal flaring, and sometimes gasping. In infants and children there also may be retraction of the skin, muscles, and other tissues around the clavicle and between the ribs.
Noisy breathing, or an abnormal sound of breathing, may include snoring, wheezing, gurgling, crowing, or stridor. Auscultate the chest with a stethoscope to determine if breath sounds are present on both sides and to identify any noisy breathing sounds not audible to the ear alone.
Remember to record your observations.
1-5.4 Differentiate between shallow, labored, and noisy breathing.
FGTC 2010 EMT-I

13. Baseline Vital Signs Breathing rhythm
Rhythm is described one of two ways:
Regular
Irregular
The breathing, or respiratory, rhythm—the regularity or irregularity of respirations—can be easily affected by speech, activity, emotions, and other factors in the conscious and alert patient. However, an abnormal respiratory rhythm—that is, an irregular pattern of respiration—in the patient with an altered mental status is a serious concern. It may indicate a medical illness, a chemical imbalance, or a brain injury. It is important to assess for adequacy of breathing by assessing the rate and volume when faced with an irregular breathing pattern and to document and report your findings.
FGTC 2010 EMT-I

14. Baseline Vital Signs Assess the pulse
A pulse represents a pressure wave of blood created by the heart’s contraction
The EMT needs to be familiar with numerous pulse locations in the body
As mentioned previously, the pulse is the pressure wave generated by the contraction of the left ventricle. It directly reflects the rhythm, rate, relative strength of the contraction of the heart and volume of blood being pumped out of the heart, and it can be felt at any point where an artery crosses over a bone and is near the surface of skin.
Describe the methods to assess the pupils.
FGTC 2010 EMT-I

15. Baseline Vital Signs Pulse Central pulses Peripheral pulses
Carotid artery
Femoral
Peripheral pulses
Radial
Brachial
Posterior tibial
Dorsalis pedis
Central pulses (carotid and femoral) and peripheral pulses (radial, brachial, posterior tibial, and dorsalis pedis) can be felt at the following locations:
 Carotid artery, on either side of the neck in the groove between the trachea and the muscle mass
 Femoral artery, in the crease between the lower abdomen and the upper thigh (groin)
 Radial artery, proximal to the thumb on the palmar surface of wrist
 Brachial artery, on the medial aspect of the arm, midway between the shoulder and the elbow between the bicep and tricep muscles
 Posterior tibial artery, behind the medial ankle bone
 Dorsalis pedis artery, on the top of the foot on the great-toe side
1-5.5 Describe the methods to obtain a pulse rate.
FGTC 2010 EMT-I

16. Baseline Vital Signs Pulse
In patients > 1 year of age, assess the radial pulse (if the patient is conscious)
If the radial pulse is absent, or the patient is unresponsive, assess the carotid pulse
A radial pulse should be assessed in all patients 1 year or older. When a peripheral pulse cannot be obtained in patients older than 1 year of age, assess the carotid pulse. When palpating the carotid pulse take care not to compress too hard, which may impede circulation to the brain. Avoid excessive pressure in elderly patients and never assess the carotid pulse on both sides at the same time.
Always try to assess pulses in several areas, both central and peripheral locations, to determine how well the entire circulatory system is functioning. If the pulse is present, assess its rate and quality.
1-5.5 Describe the methods to obtain a pulse rate.
FGTC 2010 EMT-I

17. Baseline Vital Signs Pulse
In patients less than one year of age, assess for a pulse at the brachial location
In patients younger than 1 year, assess a brachial pulse. Always try to assess pulses in several areas, both central and peripheral locations, to determine how well the entire circulatory system is functioning. If the pulse is present, assess its rate and quality.
FGTC 2010 EMT-I

18. Baseline Vital Signs Pulse Assessing pulse quality and rhythm
Common descriptors
Strong
Weak
Regular
Irregular
The quality of the pulse can be characterized as strong or weak, the rhythm regular or irregular.
 Strong pulse usually refers to a pulse that is both full and normally strong. A “bounding” pulse is one that is abnormally strong.
 Weak pulse is one that doesn’t feel full or may be difficult to find and palpate. A weak pulse may also be quite rapid. The general term for a weak, rapid pulse is “thready.”
 Regular pulse is usually a normal pulse that occurs at regular intervals with a smooth rhythm.
 Irregular pulse is one that occurs at irregular intervals, which may indicate a cardiac disease.
1-5.7 Differentiate between a strong, weak, regular, and irregular pulse.
FGTC 2010 EMT-I

19. Baseline Vital Signs Skin
The appearance and condition of the skin is another indicator of the body’s perfusion status
You should assess the temp, color, condition, and capillary refill
Skin color indicates how well the blood is being oxygenated and circulated to the skin and, therefore, how well the lungs and heart, respiratory and circulatory system, are functioning. In all patients, check the color of the nail beds, oral mucosa (mucous membranes of the mouth), and conjunctiva (mucous membranes that line the eyelid). They all should be pink. In infants, children, and dark-skinned people, check the palms of the hands and the soles of the feet. They should be pink, too.
1-5.8 Describe the methods to assess the skin color, temperature, and condition (capillary refill in infants and children).
FGTC 2010 EMT-I

20. Baseline Vital Signs Skin Color Normal Pale Cyanotic Flushed Jaundice
Mottled
Abnormal skin colors include:
 Paleness, or pallor, may be a sign of extreme vasoconstriction, blood loss, or both.
 Blue-gray color, or cyanosis, indicates inadequate oxygenation or poor perfusion. It often appears first in the fingertips and around the mouth. Cyanosis always indicates a serious problem but often is seen very late.
 Red color, or flushing, may be a sign of heat exposure, vessel dilation, or very late carbon monoxide poisoning.
 Yellow color, or jaundice, may indicate liver disease.
 Mottled is a discoloration similar to cyanosis, however, it occurs as a blotchy pattern. This may be seen in some shock patients.
1-5.9 Identify the normal and abnormal skin colors.
Differentiate between pale, blue, red, and yellow skin color.
FGTC 2010 EMT-I

21. Baseline Vital Signs Skin Skin temperature
Most common measure used prehospitally
Various temperature abnormalities may be noted:
Hot, cool, cold
The most common measurement of temperature in the field is relative skin temperature. This can be assessed by placing the back of your hand against the patient’s skin. Relative skin temperature is not a precise measurement but is a good indicator of abnormally low or high temperatures.
Normal skin feels warm to the touch. Abnormal skin temperatures include:
 Hot, which indicates a fever or exposure to heat
 Cool, which may be a sign of inadequate circulation, shock, or exposure to cold
 Cold, which indicates extreme exposure to cold
Identify the normal and abnormal skin temperature.
Differentiate between hot, cool, and cold skin temperature.
FGTC 2010 EMT-I

22. Baseline Vital Signs Skin Skin temperature
How to assess for temperature
Reinforce assessment.
FGTC 2010 EMT-I

23. Baseline Vital Signs Skin Skin condition Normal Abnormal Dry
Wet or moist
Abnormally dry
Normally, skin is dry. Wet or moist skin may indicate shock (hypoperfusion), poisoning, a heat-related, cardiac, or diabetic emergency, or many other conditions. Skin that is abnormally dry may be a sign of spinal injury or severe dehydration.
Identify normal and abnormal skin conditions.
FGTC 2010 EMT-I

24. Baseline Vital Signs Skin Capillary refill
Amount of time for a compressed capillary bed to refill with blood
Most reliable in infants less than 6 months old
Can be assessed in the older patient, but other factors may influence the response
The time it takes for compressed capillaries to fill up again with blood is called capillary refill time. It is more of a reliable sign in infants and children less than 6 years of age since they usually have very little existing disease that might affect the perfusion in the capillaries.
It is acceptable to assess the capillary refill in the adult patient; however, be aware of the influence that cold, poor preexisting circulation problems, and certain medications could have on the capillary refill. Keep in mind this is only one measure.
To measure capillary refill, press firmly on the skin or nail bed. When you remove your finger, the compressed area will be white. Count the time it takes to return to the original color. Normally capillary refill times vary based on the patient’s age, current disease states, and temperature of the environment. When assessed at room temperature, the upper limits of normal capillary refill times are 2 seconds for infants, children, and male adults; 3 seconds for females; and 4 seconds in the elderly. When it takes longer, the circulation of blood through the capillaries may be inadequate, indicating that the patient is suffering from shock (hypoperfusion).
Identify normal and abnormal capillary refill in infants and children.
FGTC 2010 EMT-I

25. Baseline Vital Signs Skin Capillary refill
No comment.
Assess capillary refill on a child by pressing forearm.
Release pressure and observe blanched area
FGTC 2010 EMT-I

26. Baseline Vital Signs Pupils Use a regular penlight
Shine the light briefly, and at an angle to the pupil, and observe the response
Assessing the pupils is another common skill for the EMT. When performing it, be sure to use a regular penlight (a device with a high intensity bulb can damage the eye and cause unnecessary pain to the patient). Also shine the light at an angle to the pupil; this also helps to reduce the discomfort of having a light shone directly at the eye.
FGTC 2010 EMT-I

27. Baseline Vital Signs Pupils
The assessment determinations for the pupillary check include:
Size
Equality
Reactivity
To assess the pupils, briefly shine a light into the patient’s eyes at an angle.
 Size. Pupils that are dilated (too large) may indicate cardiac arrest or the use of certain drugs including LSD, amphetamines, and cocaine. Pupils that are constricted (too small) may indicate a central nervous system disorder, the use of narcotics, or a brightly lit environment.
 Equality. Pupils of unequal size may indicate a stroke, head injury, an artificial eye, disease of the eye, use of some eye drops, or injury to the eye or nerve that controls the pupil.
 Reactivity refers to the pupil changing in size in response to light shined in the eye. The pupils, which are most often normally midsize, will constrict when light is shined in them. The pupils will dilate when shaded or in a dark environment. Both pupils will have the same response, even when the light is shined in only one eye. This is called a consensual reflex.
Differentiate between reactive and nonreactive pupils and equal and unequal pupils.
FGTC 2010 EMT-I

28. Baseline Vital Signs Pupils Note the variances in size
Discuss normal and abnormal pupillary findings.
Identify normal and abnormal pupil size.
Differentiate between dilated (big) and constricted (small) pupil size.
FGTC 2010 EMT-I

29. Baseline Vital Signs Pupils Common findings and possible causes
No comment.
FGTC 2010 EMT-I

30. Baseline Vital Signs Blood pressure
Measurement of the amount of pressure in the arteries as blood flows through them
Function of many variables
Cardiac output
Degree of arterial constriction (systemic vascular resistance)
When the left ventricle of the heart contracts, it ejects blood into the aorta and throughout the arteries of the body. The pressure that is exerted on the walls of the arteries by the blood flowing through them is referred to as the blood pressure. The blood pressure normally includes two readings: the systolic blood pressure and the diastolic blood pressure.
FGTC 2010 EMT-I

31. Baseline Vital Signs Blood pressure
Blood pressure measurement normally includes two readings:
Systolic
Diastolic
Measured by a sphygmomanometer
Measured in millimeters of mercury (mmHg)
The top number is always the systolic blood pressure, which is the amount of pressure exerted on the walls of the arteries during the contraction and ejection of blood from the left ventricle. The systolic blood pressure correlates with the wave of blood that creates the pulse. Therefore, the pulse is an assessment of the systolic blood pressure. If the systolic blood pressure is low, the pulse will be weak or absent.
The bottom number is always the diastolic blood pressure, which is the amount of pressure on the artery walls while the ventricle is at rest and not contracting. The diastolic blood pressure is related to both the amount of blood in the artery and the size of the diameter of the artery. If the artery is constricted (diameter is made smaller), the diastolic blood pressure will increase. During auscultation, the diastolic blood pressure is recorded when the systolic sound disappears or changes drastically.
Define systolic pressure.
Define diastolic pressure.
FGTC 2010 EMT-I

32. Baseline Vital Signs Blood pressure Adult male
Systolic equals100 mmHg + patient age
Systolic greater than 140 mmHg is considered hypertension
Diastolic normally 60–90 mmHg
Diastolic greater than 90 mmHg is considered diastolic hypertension
In the adult male patient at rest who is less than 40 years of age, add the patient’s age to 100. As an example, a 32-year-old male patient would have an estimated normal systolic blood pressure of 132 mmHg ( years = 132 mmHg). A systolic blood pressure greater than 140 mmHg would be considered a mild form of hypertension (high blood pressure). The normal range for the diastolic blood pressure is between 60 to 90 mmHg. Any diastolic blood pressure greater than 90 mmHg is referred to as diastolic hypertension.
FGTC 2010 EMT-I

33. Baseline Vital Signs Blood pressure Adult female
Systolic equals 90 mmHg + patient age
Diastolic normally 60–90 mmHg
Diastolic greater than 90 mmHg is considered diastolic hypertension
Since an adult female’s blood pressure is typically 8 to 10 mmHg lower than in an adult male, you would take the patient’s age in years plus 90 mmHg to estimate the normal blood pressure of an adult female at rest. As an example, a 28-year-old female would have an estimated systolic blood pressure of 118 mmHg ( = 118 mmHg). The adult female’s diastolic blood pressure is normally 60 to 90 mmHg. Any pressure greater than 90mmHg is considered to be diastolic hypertension.
FGTC 2010 EMT-I

34. Baseline Vital Signs Blood pressure Child 1–10 years old
(Child’s age x 2) + 80 mmHg
Child or adolescent greater than 10 years
Minimum systolic of 90 mmHg
In children between 1 and 10 years of age, the normal expected systolic blood pressure is calculated by taking the child’s age times 2 and then adding it to 80 mmHg.
The lower limit of normal of a systolic blood pressure in an infant from birth to 1 month of age is 60 mmHg, and from 1 month to 1 year is 70 mmHg. This provides you with a quick reference when estimating blood pressures in children.
The diastolic blood pressure is normally two-thirds the systolic blood pressure. As an example, a child with a systolic blood pressure of 90 mmHg would have an expected diastolic blood pressure of 60 mmHg.
Child or adolescent greater than 10 years. Children greater than 10 years of age would have a minimum systolic blood pressure of 90 mmHg. A blood pressure less than the minimum expected blood pressure would be a possible indication of shock.
FGTC 2010 EMT-I

35. Baseline Vital Signs Pulse pressure
Difference between systolic and diastolic pressures
Less than 25% of systolic = narrow pulse pressure
Greater than 50% of systolic = widened pulse pressure
The difference between the systolic blood pressure and the diastolic blood pressure is called the pulse pressure. As an example, if the patient’s blood pressure is 124/80, the pulse pressure would be 44 mmHg (124 – 80 = 44 mmHg). If the pulse pressure is less than 25 percent of the systolic blood pressure, it would be considered a narrow pulse pressure. If the pulse pressure is greater than 50 percent of the systolic blood pressure, it would be considered a widened pulse pressure. Using the example just given, a narrow pulse pressure would be less than 31 mmHg (124  .25 = 31 mmHg) and a widened pulse pressure would be greater than 62 mmHg (124  .50 = 62 mmHg).
Normally, the two blood pressures will rise and fall together. However, there are conditions in which the systolic and diastolic readings will become closer together than normal (narrow pulse pressure) or become much further apart (widened pulse pressure). These are important indicators of possible conditions or injuries that patient may be suffering.
FGTC 2010 EMT-I

36. Baseline Vital Signs Blood pressure By auscultation By palpation
There are two methods of obtaining blood pressure that the EMT may elect to use.
Auscultation—with auscultation the EMT will listen for the systolic and diastolic sounds using a stethoscope.
Palpation—with palpation the EMT will feel for the return of the pulse with deflation of the cuff. When the pulse returns, this becomes your systolic number.
Also reinforce for the students the importance of accurately documenting the patient’s vital signs.
Describe the methods to assess blood pressure.
Explain the difference between auscultation and palpation for obtaining a blood pressure.
State the importance of accurately reporting and recording the baseline vital signs.
By auscultation
By palpation
FGTC 2010 EMT-I

37. Baseline Vital Signs Orthostatic vital signs
Do not attempt orthostatic vital signs in patients with possible spinal injury
Positive orthostatic (tilt) test
Increase in heart rater greater than 10–20 bpm
Decrease in blood pressure of 10–20 mmHg
In a patient with suspected volume loss, you may be asked to obtain a set of orthostatic vital signs. This is done by taking the patient and placing him in a supine position and measuring his blood pressure and heart rate. Stand the patient up and after two minutes reassess the blood pressure and heart rate.
If the heart rate increases by greater than 10 to 20 bpm and the systolic blood pressure decreases by 10 to 20 mmHg, this is considered to be a positive orthostatic test, which typically indicates a significant loss of blood volume. This is also commonly known as the tilt test.
You must be careful when using the systolic blood pressure reading as a guide to this test since a large percentage of patients, especially the elderly, may experience a normal drop in their systolic blood pressure when they have not lost any volume.
An increase in heart rate has been found to be a much more sensitive indicator of blood loss when checking orthostatic vital signs.
FGTC 2010 EMT-I

38. Baseline Vital Signs Pulse oximetry
Method of measuring the oxygen saturation levels in the blood
Readings
97% to 100% SpO2 is normal
<95% SpO2 indicate hypoxia and compromise
The pulse oximeter provides a reading as a percent of hemoglobin saturated with oxygen. This is recorded as % SpO2 which indicates the reading was measured by a pulse oximeter.
A normal pulse oximeter reading for a person breathing room air is in the high 90s, typically 97% through 100% SpO2. A pulse oximeter reading in a compromised patient that is less than 95% indicates hypoxia. Therefore, any SpO2 reading of less than 95% in a patient must be investigated and oxygen must be applied to the patient. If the SpO2 reading is 90% or less, it is an indication of severe hypoxia.
Assess your patient carefully paying close attention to his respiratory rate and tidal volume. He may need to be ventilated if either the rate or tidal volume is found to be inadequate. Apply oxygen to the patient. Be aggressive in your management of the patient since the result of severe and prolonged hypoxia is cell death.
FGTC 2010 EMT-I

39. Baseline Vital Signs Pulse oximeter
The pulse oximeter provides a reading as a percent of hemoglobin saturated with oxygen. This is recorded as % SpO2 which indicates the reading was measured by a pulse oximeter.
A normal pulse oximeter reading for a person breathing room air is in the high 90s, typically 97% through 100% SpO2. A pulse oximeter reading in a compromised patient that is less than 95% indicates hypoxia. Therefore, any SpO2 reading of less than 95% in a patient must be investigated and oxygen must be applied to the patient. If the SpO2 reading is 90% or less, it is an indication of severe hypoxia.
Assess your patient carefully paying close attention to his respiratory rate and tidal volume. He may need to be ventilated if either the rate or tidal volume is found to be inadequate. Apply oxygen to the patient. Be aggressive in your management of the patient since the result of severe and prolonged hypoxia is cell death.
Pulse oximeter
Pulse oximeter applied to patient’s finger
FGTC 2010 EMT-I

40. Baseline Vital Signs Vital sign reassessment
Stable patients should have vitals assessed at least every 15 minutes
Unstable patients should have vitals assessed at least every 5 minutes
Reassess vitals after each medical intervention
If the patient is stable, vital signs should be taken and recorded at least every 15 minutes and as often as necessary to assure proper care. Take and record vital signs every 5 minutes if the patient is unstable. Reassess vital signs immediately following every medical intervention, regardless of how soon it follows your previous assessment of vital signs.
Clinically, you should reassess vitals every chance you get; this shows stability—or reveals early instability.
FGTC 2010 EMT-I

41. SAMPLE History
The SAMPLE history is a medical history of the patient that you gather by asking questions indicated by the acronym
Explain the importance of gathering a good medical history from the patient, how it relates to the field impression of the problem, and how it is incorporated into patient care.
FGTC 2010 EMT-I

42. SAMPLE History SAMPLE Signs and symptoms
A sign is an objective assessment finding that you can see, hear, feel, or smell
A symptom is a subjective assessment finding that you cannot observe, and must be described by the patient
Signs and symptoms. Signs are any objective physical evidence of medical or trauma conditions that you can see, hear, feel, or smell. For example, you can hear stridor, you can see bleeding, and you can feel skin temperature.
Symptoms are conditions that cannot be observed and must be described by the patient, such as pain in the abdomen or numbness in the legs. When you begin to question the patient, ask: What are you feeling? When and where did the first symptoms occur? What were you doing at the time? Another mnemonic used to evaluate the patient’s symptoms is OPQRST (onset, provocation/palliation, quality, radiation, severity, and time).
Identify the components of the SAMPLE history.
Differentiate between a sign and a symptom.
FGTC 2010 EMT-I

43. SAMPLE History SAMPLE Signs and symptoms OPQRST: Onset
Provocation / palliation
Quality
Radiation
Severity
Time
No comment.
FGTC 2010 EMT-I

44. SAMPLE History SAMPLE Allergies
Determine whether the patient has any allergies to medications, food, or environmental agents such as pollen, grass, ragweed, or molds. If you have not already done so during the physical exam, check for a medical alert tag, necklace, anklet, or bracelet, which can alert you to an allergy or other medical problem.
Identify the components of the SAMPLE history.
Discuss the need to search for additional medical identification.
FGTC 2010 EMT-I

45. SAMPLE History SAMPLE Medications
Current medications taken by the patient
Prescription
Nonprescription
Illicit
Has the patient taken any medications recently? Is the patient taking any medications regularly? It is important to determine if the patient takes (1) prescription medications, (2) nonprescription or over-the-counter medications, (3) birth control pills, or (4) illicit drugs. If you suspect illegal drug use, you might say something like, “I’m an EMT, not a police officer. I need all the information you can give me so I can provide the proper care. Let’s work on helping you right now.” As with allergies, look for a medical alert tag if the patient is unresponsive.
Identify the components of the SAMPLE history
FGTC 2010 EMT-I

46. SAMPLE History SAMPLE Pertinent past history
Underlying medical problems
Past surgical procedures
History of significant trauma
If under a doctor’s care at this time
Find out about underlying medical problems like epilepsy, heart disease, diabetes, kidney disease, or emphysema. Ask if there have been past surgical procedures or trauma, and whether or not the patient is currently under a doctor’s care. Again, look for a medical alert tag if the patient is unresponsive.
Identify the components of the SAMPLE history
FGTC 2010 EMT-I

47. SAMPLE History SAMPLE Last oral intake
Last ingestion of solid or liquid
Approximate time and quantity of last ingestion
Find out when the patient last ingested a solid or liquid. Find out what it was, when it was consumed, and the quantity that was consumed. Ask: When did you last eat or drink anything?
Identify the components of the SAMPLE history.
FGTC 2010 EMT-I

48. SAMPLE History SAMPLE Events leading up to illness or injury
What was the patient doing prior to emergency?
Were there any unusual circumstances?
Did the patient experience any peculiar feelings?
Events leading to the injury or illness. What occurred before the patient became ill or had the accident? Were there any unusual circumstances? What was the patient doing? Did the patient have any peculiar feelings or experiences?
Identify the components of the SAMPLE history.
FGTC 2010 EMT-I

49. SAMPLE History
This is the basis for focusing the remaining aspect of assessment sequences
Failure to obtain reliable information will naturally lead to wrong decisions—and potentially—improper care
The EMT-B should be diligent when obtaining both these and other assessment findings
Summarize important points.
FGTC 2010 EMT-I